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 Multicultural and Contextual Considerations Case Study: Marisol Program Transcript [MUSIC PLAYING] NARRATOR: Professional counselors consider all facets of a client’s personal background and history to provide informed ethical care. As such, individuals belonging to special or minority populations require additional consideration on the part of the counselor to ensure appropriate care is given. In the case that you’re about to view, Marisolthe clientpresents with special ethnographic needs. As the client is introduced, consider possible areas in which the client requires a treatment approach that incorporates culturally sensitive considerations. Think of ways to align specific addiction and mental health concerns with cultural considerations. How should this client be assessed? What alternative approaches should the counselor employ to address multicultural barriers? Marisol is a 25-year-old Latina living in a traditional home on the south side of San Antonio, Texas. Marisol has lived in the United States for most of her life and has extended family in Mexico and in San Antonio. She is the middle child of six. Her family and friends are pressuring her to get married. Her grandmother, mother, and married friends consistently bring up the subject of marriage. Marisol worries about her ability to be a good wife and mother and sees her siblings struggle to lead a good life as much as she does. Marisol is fluent bilingual. However, English is Marisol’s second language. Although she wanted to succeed in her studies, Marisol struggled as a student and did not finish high school. She was always nervous in school. She began working to contribute to the family income and could never find the time to complete a GED. She worries that she will never be able to get a good job because of her lack of education. Marisol is being treated for comorbid cocaine abuse and benzodiazepine dependence and is having difficulty discussing her mental health issues with her Caucasian male psychiatrist. Marisol has been seeing her psychiatrist, Dr. Dan, for treatment of her addictions. Dr. Dan is a Caucasian master’s level counselor who has received specialized training in addictions counseling. During the past two counseling sessions, Marisol appeared reluctant to engage in communicating with her psychiatrist as evidenced by her limited verbalizations. She responded only to questions that were asked and provided little additional  

2014 Laureate Education, Inc. 1 

Multicultural and Contextual Considerations Case Study: Marisol information beyond yes and no responses. Her responses have sometimes appeared to be insincere or evasive. MARISOL: I met with my doctor two times. Dr. Dan wants me to tell him what is going on with me. But when I started to tell him a little bit, he seemed impatient. These are the things that I don’t like to talk about, especially with someone who’s not a member of my family. If I share too much, he may think I’m a bad woman. He is a doctor, so what he says goes. He knows what he needs to know from me, and I don’t want to trouble him. I like Dr. Dan. He seems nice and all that, but I really don’t feel like he can understand my problems. First, I don’t think he’s ever had addiction himself. If he hasn’t had an addiction, how can he possibly understand what I’m going through? He’s also a white man. The issues I face as a Latina woman are very different than those that he experiences. I just don’t understand how he will be able to help me. Let me tell you a little bit about myself. I’m 25 years old, and I’ve been using drugs for the past 10 years. I only really started using drugs to help with my anxiety. [SPEAKING SPANISH]. Sometimes, when I get nervous, I forget to talk in English. Anyway, I’ve been nervous for as long as I can remember. I’ve justI’ve had some bad stuff happen, stuff that I don’t want to talk about right now. How am I supposed to talk to a man about these things? I know that in order to get better, I have to talk about things. But I can’t bring myself to talk about them with an educated man like this. I mean, I tried to start telling him, but he was like in a hurry or something. He started writing a prescription for me. You must know what I mean. AndI don’t know, maybe I shouldn’t talk so much, you know? Where was I? Oh, yes, my anxiety. I guess I can tell you a little bit about it. Please don’t tell my mother. I had some bad stuff happen. But even before that, we just really struggled to make it. I was raised by a single mother, una santa. She’s a saint. She worked 14 hours a day to make sure that [INAUDIBLE] and the rest of us had food in our system. We also moved a lot. And sometimes, I was unsure if I should even unpack, or if we were just going to up and leave. Like I was saying, my mother worked 14 hours a day. She worked two jobs. 2014 Laureate Education, Inc. 2 

Multicultural and Contextual Considerations Case Study: Marisol And she left us kidsthere were six of uswith whoever was willing to watch. Like mi tia, Alejandra. I’m sorry, my aunt. It was hard on all of us. We fought a lot. All of my siblings have problems, giving my mother grief. My oldest brother, Juan, has spent most of his life in and out of prison. He joined up with MA, so he’s all tough and gang banger now. My sisters are in abusive relationships. I don’t think they know how to keep their men happy. And my youngest brother, my youngest brother, he’s had the hardest because he saw too much too early. We used to party sometimes together, you know? But he’s worked so much. These days, he parties just as hard as he works. I think he’s stuck on [INAUDIBLE]. Things have been hard for us all. My poor motherI try to keep it together because I know that she needs at least one daughter she can be proud of. It’s too much. I think that’s why I started using alcohol. I used alcohol first. It was a way to help me relax and forget about my problems. Plus, I mean, Tia Alejandra said she had been drinking back at age 12 in Chiapas. No big thing. I never really liked feeling hung over. Then I started taking Xanax. I really liked the way that made me feel. I didn’t feel the anxiety as much. I could get out of the house, go make friends, and everything. But then I started needing more and more, and that scared me. I’ve had friends who overdose, and others get sick from that stuff. I thought, I’ll just cut back. I even had an attack the day I tried to not take it. Itit felt like if my heart was going to explode. So I called the counseling center, and they had me see Dr. Dan. They told me to come see you too. I sometimes use cocaine. I don’t really like the way it makes me feel, though. It usually just makes me feel more anxious. I know it sounds stupid, but sometimes I feel like if the cocaine gets me too up, I’ll be too up to even care about being anxious. Yeah, you know, it’s like I can take it. Anyway, I can talk to people and not feel so stupid all the time, you know? I just want to feel better. I want a normal life. I want my mother to be proud of me. I know that using cocaine and Xanax are very wrong for me. But I just don’t want to feel anxious every day. I don’t want to feel anxious every day. II haven’t been in a relationship in over three years. And I’m afraid that I can’t trust anyone. What kind of woman am I if I can’t keep a husband and have a house and have my husband happy with the way I make things work? 2014 Laureate Education, Inc. 3 

Multicultural and Contextual Considerations Case Study: Marisol It’s all too much. So like, I can’t tell Dr. Dan any of this stuff. I’ll be so ashamed. I mean, he is the doctor, right? He’ll want to lock me up or tell me that it’s my mother’s fault. She’s a good woman. She’s worked so much. I wish I could be like that, you know? What if she found out? It would kill her. I don’tI just think I won’t go back. I can’t stand the judgment. Dr. Dan. He can’t even pronounce my name right. “Mare-ah-saul”. It’s “Mar-ie-sole.” I just might not come back. I can’t stand the judgment. Maybe my anxiety isn’t so bad. Maybe I could just cut back on the Xanax and maybe only do coke like in the weekends or something. I think I’m wasting his time 

Mental health professionals appreciation for  culture and context extend beyond general understandings of people  grouped by factors like ethnicity and sexual orientation. Mental health  professionals invest in understanding the deep, underlying components of  all the things that come together to make our clients who they are.

When  culture and context are at odds with societal norms and hegemonic  expectations, mental health professionals may need to work with clients  to help instill and utilize resources to cope with the possibility of  negative messages from society. In addition, mental health professionals  work together with clients, for clients, and with other professionals  to make changes. Consider how collaborating with others promotes  positive changes in client well-being. How might collaboration through  advocacy result in alternative approaches for addressing cultural or  contextual considerations in treatment recommendations?

For  this Discussion, view the media Multicultural and Contextual  Considerations Case Study: Marisolin the Learning Resources. Consider  new and alternative methods that mental health professionals could use  to advocate for Marisol.

By Day 4

Post an explanation of how you  would advocate for clients like Marisol. Explain at least one strategy  as a mental health professional you could facilitate culturally and  contextually ethical treatment of clients. Support your strategy with  evidence from the Walden Library.